It’s been a long time since I’ve wanted to link to an article at The Atlantic. For decades a great magazine that was reliably substantial and well-written, it’s now an SJW-infested clusterfuck that too often reads like it’s being written and edited by ambitious Cultural Studies undergrads.

Forgive a short detour: In the last ten years, many media outlets, in their struggle to cut costs in the digital age, have sent their older employees packing. The impact of this trend on our public discussion hasn’t received nearly enough recognition, IMHO. Whatever the faults of the older crowd — and I say this as one of them (I was retired-with-a-bonus from a MSM magazine in 2008) — they’d seen a lot and they’d dealt with a lot. They had thick hides as well as a healthy cynicism towards both their subjects and their bosses. By contrast, today’s youthful MSM staffers, while having the virtues of energy and tech-savviness, often seem completely unworldly as well as over-eager to please the powers-that-be. When I scroll or leaf through today’s news-oriented magazines and newspapers, I invariably come away with a general impression of callowness and wet-behind-the-ear-ness. It’s as though the writers and editors are dealing with their subjects for the very first time. Wide-eyed freshness can be a virtue in lyric poetry; in journalism maybe not so much.

Takeaway: if our public discussion has come to feel like it’s being conducted by 13 year olds, it isn’t just because you yourself are growing older and more cranky. It’s also because a lot of the people supplying us with reporting and opinions these days really are near-children.

But back to the point of this posting, which is to link to an article by David Epstein. It’s about unnecessary and unhelpful medical treatments that nonetheless continue getting prescribed, and it’s a well-reported, provocative beauty. Why, Epstein asks, even in cases when the best studies show that some treatments are useless or worse, do patients continue demanding them? And why do doctors continue providing them?

Excerpt:

For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.

Even if a drug you take was studied in thousands of people and shown truly to save lives, chances are it won’t do that for you. The good news is, it probably won’t harm you, either. Some of the most widely prescribed medications do little of anything meaningful, good or bad, for most people who take them.

Epstein’s piece is full of eye-opening examples. One of my favorites is treatments that will make your body hit the sought-after numbers — pills, for example, that bring some blood marker into the desired range, or that lower your blood pressure to “normal” — yet that won’t prolong your life or help you avoid catastrophes. What’s the point of them? Does it matter if your numbers look good if you get sick and die anyway?

Epstein got me thinking over a number of things. I’ve been accompanying an in-law to the hospital for chemo treatments, for example, and so have had a lot of time to observe the scene there. Good lord but there are a lot of fat people and smokers among the patients. People who have just had dumb accidents and homeless people too. One ambulance guy I gabbed with recently told me that 70-80% of the ambulance runs he and his team make are for homeless people. “A lot of them are drunks and addicts. Sometimes they really need treatment but often they just want attention,” he said to me. “You run out of compassion for them pretty quickly.” And a surgeon I knew once said to me that American hospitals would be half as crowded as they are — and America’s perpetual health-care crisis would be much alleviated — if Americans did four things: 1) Avoided getting obese. (“Overweight isn’t a problem,” he said. “Obese is.”) 2) Avoided getting addicted to drugs or booze. 3) Didn’t smoke. 4) Took more care to avoid preventable accidents — falls from ladders, that kind of thing.

These musings led me to two (very amateurish, but hey, I been around) reflections:

It’s probably a mistake to think of our bodies as mechanical things — or, to be more up to date, as cyborgs. That view tends to lead people to think of their bodies as a device detached from them that needs the occasional visit to the garage, or maybe the occasional attentions of Apple Geniuses. If you’ve got a pain or a gripe, drop your body off at the hospital and get it worked on. Problem solved. In my experience it all too often doesn’t work out quite so simply. For all the things that modern medicine is good for, I can’t tell you the number of times friends have had back operations or knee replacements or heart stents that haven’t finally done them much good. And, even when these treatments do work out well, the pain, horror and shock of the experience is something people are rarely ready for. Bodies aren’t machines; they’re sacks of wet, gloppy biological materials. They really don’t like being knocked out and cut into. Another big surprise: trauma to the body (and surgery is extreme trauma to the body) tends to have big, unpredictable mental and emotional consequences. You aren’t just dropping your jalopy off at the shop; you’re putting your very being on the line. It isn’t at all rare for people having surgery to come out of the experience feeling quite changed (and often not in a good way) by it.

We’re mistaken when we look to Western medicine to make us feel good. Western medicine is brilliant at fixing bone-breaks, at sewing up bullet holes, at curing some cancers and helping with diabetes. But can it really make you feel good in the “I’m experiencing ease and purpose” sort of way? Is it even meant to? Yet that’s exactly what many people look to it for. I can’t tell you the number of friends I have who are, in their quest to feel a little better, taking a half a dozen pills a day. People get hooked on a medication then need more medications to take care of the side effects of it. “There’s no such thing as a medicine that doesn’t have side effects,” a Harvard Med School doc once told me. “Even aspirin has side effects.” My friends swirl around and around, getting groggier and groggier, trying to extinguish symptoms that they themselves have created, and never ever achieving the desired state of feeling pretty good.

Epstein is, btw, very good on the “why?” part of his topic: Why do doctors prescribe these treatments? Why do patients demand them? I think it’s beyond-understandable that people today should look to medicine for miracles. These days, where else are they going to look? It’s too bad, though, if doctors and medicine hold out promises they can’t really deliver on, and it can backfire when people project their larger hopes onto medicine. A little less confusion, heartbreak and pain would be nice.

Fwiw, my working theory about how to proceed is: use Western medicine for what it’s good for, but generally avoid it. For everyday health — and especially for that elusive “feeling good” thang — rely first on eating well, on moderate exercise, on living a modest and low-stress life, and on being conscientious with your mental/emotional hygiene. Qigong, yoga, meditation, massage, swimming, etc, can all do a soul a world of good. Incentive: it never hurts to remember that doctor and hospital goofs may be the third leading cause of death in the U.S. If you’re hit by a car or need a tumor removed, by all means get yourself to a doctor, and do it pronto. Otherwise, why expose yourself to more medical treatments than you probably really need?

Related

At my old blog I wrote about receiving a diagnosis of cancer and going through surgery for it. An epilog to that story: I’ve begun to wonder if the surgery was necessary. As thinking about prostate surgery has progressed in the years since my operation, many doctors have come to suspect that there may be several different kinds of my kind of cancer, some of which will kill you no matter whether you’re treated or not, and some of which won’t kill you no matter the treatment. That would certainly jibe with my experience. A good friend of mine was diagnosed with the same cancer I had. His markers and my markers were almost identical — in other words, as far as medicine was concerned and could tell, we were virtually identical cases. And we received identical treatments. Yet he was dead from his cancer within five years while I’m still around and in good shape. So: given that I may have had a brand of cancer that I’d have survived in any case, why did I go through the gruesome, life-changing procedure I did?

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About Paleo Retiree

Onetime media flunky and movie buff and very glad to have left that mess behind. Formerly Michael Blowhard of the cultureblog 2Blowhards.com. Now a rootless parasite and bon vivant on a quest to find the perfectly-crafted artisanal cocktail.

13 Responses to Treatments Bad and Good

I live your advice, and can in fact count the numbers of times I’ve been to a doctor in the last 25 years: 7. On the other hand, both my parents are healthy and active in their 80s so maybe I just won the lottery.

Thanks for the reminder to stay away from the doctor, in general. I wonder if this lowers the opportunity cost of living abroad, Western Europe say? W a more meager medical establishment, I may die some months earlier, but otherwise enjoy lower costs and less interference.

It’s the Holzbachian! Great to see you hanging out online. Yeah, I’m with you, too much late-in-life medical care goes into sustaining people for another few months, and while another few months might possibly be nice (and hard to decline), too often they’re an extra few months of agony and misery. What’s the point of that?

Couldn’t agree more about surgery. My father was a physical therapist for 30 years and always told his patients to avoid surgery at all costs unless they were in constant pain. Of course, when he got a recommendation for neck surgery, dammit he went and did it. And the results have been AWFUL. Like you say, people are looking for a fix, most of the time for something beyond the physical. I was heartened to read about the recent American College of Physicians new recommendation of yoga instead of pills/surgery for back pain. I’ve been saying for years yoga classes should be covered under insurance, it would save this country billions of dollars.

Sorry to hear about your dad’s bad luck. What kind of shape is his neck in these days?

You’re reminding of one older male relative of mine who’d been having terrible back pain and who decided to have surgery for it. The surgery (for stenosis) was a success — MRIs and X-rays showed that the pinchy bone overgrowth that was supposedly the source of his troubles had been fully ground away. But my relative has experienced no relief from his back pain at all. That’s a $40,000 operation (and months out of my relative’s life) that has provided zero benefit. I know almost no families that don’t have similar stories to tell.

I had gall bladder surgery in January – laparoscopic. It was a breeze. I think it must fit in your clump of “bone breaks, bullet holes, etc.,” somewhere. In the hospital at 5:30 a.m., home by 12:30 p.m. A surgery that nearly killed my father 50 years earlier. I don’t doubt that surgery is traumatic for bodies, especially as it used to be practiced. But, there’s something a bit anachronistic about your accounts of surgery or highly colored by your personal experience. Some surgeries are getting *much* less invasive and it’s safe to assume that trend will continue. But, then, sometimes I am very blue sky about the march of technology.

But, facing a terminal disease, would you really not undergo surgery that might (or might not) help? That doesn’t argue the efficacy of the medicine, of course. Just, wouldn’t you want to try?

A few random thoughts your blog prompted. Re: hitting some “sought after numbers,” deeming the treatment was a success, but the patient dies anyway. This strikes me more & more as a BIG problem in humans. I’ve read about it somewhere – can’t remember where – the idea being that the measure or criterion takes over the phenomenon – no matter what the field of study. I’m not saying it quite right. But, we get very focused on some criterion and it may, in fact, be arbitrary or not related to the problem like we believe it is. I think where I first read about this had to do with monetary policy, but maybe not. We set a criterion and focus on meeting the criterion, avoiding the criterion – whatever it is – and the real good we meant to pursue escapes or is obscured. Maybe this is a trap door among us Western goal-oriented types.

As to the medications – I’ve seen that happen with my brother – prescribed medication for heart disease, which has side effects that contribute to diabetes, which he takes medication for, which has side effects of arthritis – or maybe the arthritis contributes to the diabetes, I forget how it cascades.

I have a friend who believes she’s gluten-intolerant. At one point she told me she was taking 19 different medications. She had been to numerous doctors – she never thought they believed her. (I believe she was trying to find one who’d say what she wanted to hear.) She did finally go off a lot of the medication and is now content, apparently, to be gluten-intolerant, dairy free. She strikes me as someone who can only allow herself to be physically sick. She can’t/doesn’t/won’t consider that she’s just unhappy with some aspects of her life.

To your list of qigong, yoga, etc., I’d add emotional brain training (EBT), which, to give a really reductive description is a mashup of gestalt and rational emotive therapy. It has given me some really helpful tools for greater emotional balance.

It may not only be that his and your prostate cancers were different (which indeed they may have been) but that differing genetic backgrounds, diets, comorbidities, etc. could cause even similar tumors to interact differently with your bodies..

We’ve gotten past shamans and witch-doctors, but people still think medicine is magic: take this pill, get this treatment done, and presto! Problem solved. Approaching medicine on a more rational level (recognizing that there can be side effects, and interactions, etc.) tends to elude most.

That said, though, the growth of alternative treatments, and/or a desire to revisit old folk remedies, or remedies from other societies, is surely not a bad thing but a good thing, to be encouraged, as surely such is equally following the empirical method as what led to our modern medicines: try something, see if it works…

And yes, that may take us back into some quackery (as with some of the remedies of shamans / witch-doctors), but if something doesn’t work, and is subsequently rejected, then we’re back out such quackery, and on a more rational search for whatever works…